The Health Care Blog – Page 108 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Not Your Father’s Job Market

Sep 21, 2021

By KIM BELLARD

If you, like me, continue to think that TikTok is mostly about dumb stunts (case in point: vandalizing school property in the devious licks challenge; case in point: risking lives and limbs in the milk crate challenge), or, more charitably, as an unexpected platform for social activism (case in point: spamming the Texas abortion reporting site), you probably also missed that TikTok thinks it could take on LinkedIn.

Welcome to #TikTokresumes. Welcome to the Gen Z workplace. If healthcare is having a hard time adapting to Gen Z patients – and it is — then dealing with Gen Z workers is even harder.

TikTok actually announced the program in early July, but, as a baby boomer, I did not get the memo. It was a pilot program, only active from July 7 to July 31, and only for a select number of employers, which included Chipotle and Target. The announcement stated:

TikTok believes there’s an opportunity to bring more value to people’s experience with TikTok by enhancing the utility of the platform as a channel for recruitment. Short, creative videos, combined with TikTok’s easy-to-use, built-in creation tools have organically created new ways to discover talented candidates and career opportunities.

Interested job-seekers were “encouraged to creatively and authentically showcase their skillsets and experiences.” Nick Tran, TikTok’s Global Head of Marketing, noted: “#CareerTok is already a thriving subculture on the platform and we can’t wait to see how the community embraces TikTok Resumes and helps to reimagine recruiting and job discovery.”

Marissa Andrada, chief diversity, inclusion and people officer at Chipotle, told SHRM: “Given the current hiring climate and our strong growth trajectory, it’s essential to find new platforms to directly engage in meaningful career conversations with Gen Z. TikTok has been ingrained into Chipotle’s DNA for some time, and now we’re evolving our presence to help bring in top talent to our restaurants.”

I Am a Decision Maker, Not a Bookkeeper

Sep 20, 2021

By HANS DUVEFELT

Perhaps it is because I love doctoring so much that I find some of the tools and tasks of my trade so tediously frustrating. I keep wishing the technology I work with wasn’t so painfully inept.

On my 2016 iPhone SE I can authorize a purchase, a download or a money transfer by placing my thumb on the home button.

In my EMR, when I get a message (also called “TASK” – ugh) from the surgical department that reads “patient is due for 5-year repeat colonoscopy and needs [insurance] referral”, things are a lot more complicated, WHICH THEY SHOULDN’T HAVE TO BE! For this routine task, I can’t just click a “yes” or “authorize” button (which I am absolutely sure is a trackable event in the innards of “logs” all EMRs have).

Instead, (as I often lament), I have to go through a slow and cumbersome process of creating a non-billable encounter, finding the diagnostic code for colon cancer screening, clicking on REFERRAL, then SURGEON – COLONOSCOPY, then freetexting “5 year colonoscopy recall”, then choosing where to send this “TASK”, namely the referral coordinator and , finally, getting back to the original request in order to respond “DONE”.

Recommendations From the Coalition for Physician Accountability’s UME-to-GME Review Committee: Winners & Losers Edition

Sep 17, 2021

By BRYAN CARMODY

If you’re involved in medical education or residency selection, you know we’ve got problems.

And starting a couple of years ago, the corporations that govern much of those processes decided to start having meetings to consider solutions to those problems. One meeting begat another, bigger meeting, until last year, in the wake of the decision to report USMLE Step 1 scores as pass/fail, the Coalition for Physician Accountability convened a special committee to take on the undergraduate-to-graduate medical education transition. That committee – called the UME-to-GME Review Committee or UGRC – completed their work and released their final recommendations yesterday.

This isn’t the first time I’ve covered the UGRC’s work: back in April, I tallied up the winners and losers from their preliminary recommendations.

And if you haven’t read that post, you should. Many of my original criticisms still stand (e.g, on the lack of medical student representation, or the structural configuration that effectively gave corporate members veto power), but here I’m gonna try to turn over new ground as we break down the final recommendations, Winners & Losers style.

A Man With Sudden Onset of Gastroparesis

Sep 16, 2021

By HANS DUVEFELT

Leo Dufour is not a diabetic. He is in his mid 50s, a light smoker with hypertension and a known hiatal hernia. He has had occasional heartburn and has taken famotidine for a few years along with his blood pressure and cholesterol pills.

Over the past few months, he started to experience a lot more heartburn, belching and bloating. Adding pantoprazole did nothing for him. I referred him to a local surgeon who did an upper endoscopy. This did not reveal much, except some retained food in his stomach. A gastric emptying study showed severe gastroparesis.

The surgeon offered him a trial of metoclopramide. At his followup, he complained of cough, mild chest pain and shortness of breath. His oxygen saturation was only 89%.

An urgent chest CT angiogram showed bilateral pulmonary emboli and generalized hilar adenopathy, a small probable infiltrate, a small pulmonary nodule and enlargement of both adrenal glands, suspicious for metastases.

He is now on apixiban for his PE, two antibiotics for his probable pneumonia and some lorazepam for the sudden shock his diagnoses have brought him.

More Laughing, More Thinking

Sep 15, 2021

By KIM BELLARD

There was a lot going on this week, as there always is, including the 20^th anniversary of 9/11 and the beginning of the NFL season, so you may have missed a big event: the announcement of the 31^st First Annual Ig Nobel Awards (no, those are not typos).

What’s that you say — you don’t know the Ig Nobel Awards? These annual awards, organized by the magazine Annals of Improbable Research, seek to:

…honor achievements that make people LAUGH, then THINK. The prizes are intended to celebrate the unusual, honor the imaginative — and spur people’s interest in science, medicine, and technology.

Some scientists seek the glory of the actual Nobel prizes, some want to change the world by coming up with an XPRIZE winning idea, but I’m pretty sure that if I was a scientist I’d be shooting to win an Ig Nobel Prize. I mean, the point of the awards is “to help people discover things that are surprising— so surprising that those things make people LAUGH, then THINK.” What’s better than that?

Healthcare could use more Ig.

Policies, Techies, VCS: Musings From a Futurist

Sep 14, 2021

By IAN MORRISON

I should’ve been in Paris last week on vacation with my wife, instead I listened in to the Policies Techies VCS: What’s Next For Healthcare conference (I’ll explain why later). Matthew Holt and Jessica DaMassa did a magnificent job of assembling the Who’s Who of digital health tech to wax lyrical about what the new kids on the block were up to, where it is all headed, and what it will mean for the system. (Full disclosure Matthew and Jess are friends of mine, I hired Matthew from Stanford almost 30 years ago to join the Institute For The Future (IFTF) and have watched proudly as he has become a Health 2.0 impresario. Jess simply deserves a gold medal for wrangling Holt and all the other tech Bros with wit, charm and intelligence).

This is a tumultuous time for digital health technology because of the pandemic and the related rise of digital solutions not to mention the very frothy investment market and massive deal flow over the last 24 months. There are a lot of exciting new faces. But, many of the companies on display have been at this for some. And for many of the old guard, like Livongo and now Transcarent Founder Glen Tullman, Athena Health and now Zus Founder Jonathan Bush, and Amwell CEO Roy Schoenberg and others this has been a much longer journey.

(Parenthetically, as a young management engineer in Canada, a position, I was not qualified for, I wrote the justification for an all-computerized hospital at the University of British Columbia in 1979! I still find it just incredibly pathetic that it has taken us 40 years to suddenly “discover” digital health. I wrote The Second Curve which forecast (among other things) the rise of digitally enabled health transformation 25 years ago! So it is hard for me to get really excited that this is either “new” or “next”.)

So, while a lot of us have been in this movie for a long time, there is something very different about the current crop of offerings. In particular, technology has advanced considerably and there are clearly new cloud and SaaS tech enabled care solutions. There is a new cadre of talented and committed investors and entrepreneurs who believe they have the capability and capital to scale meaningful enterprises that will disrupt incumbent healthcare players and better serve consumers and providers. And the timing seems right as the pandemic forced consumers and the health care system to confront new ways of doing business.

Metaverse and Health Care – A View From 50,000 Feet

Sep 13, 2021

by MIKE MAGEE

dystopian
[disˈtōpēən]
ADJECTIVE
1. relating to or denoting an imagined state or society where there is great suffering or injustice.
NOUN
1. a person who imagines or foresees a state or society where there is great suffering or injustice.

There are certain words that keep popping up in 2021 whose meanings are uncertain and which deserve both recognition and definition. And so, the offering above – the word “dystopian.” Dystopian as in the sentence “The term was coined by writer Neal Stephenson in the 1992 dystopian novel Snow Crash.”

One word leads to another. For example, the above-mentioned noun, referred to as dystopian by science fiction writer Stephenson three decades ago, was “Metaverse”. He attached this invented word (the prefix “meta” meaning beyond and “universe”) to a vision of how “a virtual reality-based Internet might evolve in the near future.”

“Metaverse” is all the rage today, referenced by the leaders of Facebook, Microsoft, and Apple, but also by many other inhabitors of virtual worlds and augmented reality. The land of imaginary 3D spaces has grown at breakneck speed, and that was before the self-imposed isolation of a worldwide pandemic.

But most agree that the metaverse remains a future-facing concept that has not yet approached its full potential. As noted, it was born out of science fiction in 1992, then adopted by gamers and academics, simultaneously focusing on studying, applying, and profiting from the creation of alternate realities. But it is gaining ground fast, and igniting a cultural tug of war.

As Doctor Burnout Climbs, Can We Save Primary Care?

Sep 10, 2021

By RONALD DIXON

Week after week, I hear from colleagues in diverse specialties about how exhausted they are from practicing medicine.

It’s no surprise that they are looking for careers outside of medicine. The demands and strain are unsustainable.

So it’s also no surprise that a recent survey showed 40% of primary care clinicians are worried that their field won’t exist in five years and that 21% expect to leave primary care in three years as a result of COVID-19-related burnout.

While COVID-19 is the tipping point, this burnout is the result of the relentless and mounting administrative burden placed on us by electronic medical records (EMRs), coding and billing requirements and prior authorizations. And then it is exacerbated by uncertainty mounting in the primary care field, with new medical care entrants popping up everywhere — from retail pharmacies to digital health startups — aiming to create their own primary care model, replacing rather than working with existing ones.

Where it All Began

The roots of this burden began three decades ago with the advent of an acronym that few outside of the healthcare world know of today — the resource-based relative value scale (RBRVS). This payment system, launched in 1989 and subsequently adopted by Medicare in 1992, led to what we know now as the foundation of the U.S. healthcare payment system.

The RBRVS system assigns procedures a relative value which is adjusted by geographic region. Prices are based on physician work (54%), practice expense (41%) and malpractice expense (5%).

Since the initiation of the scale, the relative value of specialist work has remained much higher than primary care. This disparate compensation, in combination with most health maintenance and patient supportive tasks delegated to primary care, has led to significant fatigue.

Anxiety, Worry or Fear? Disappointment, Grief or Depression?

Sep 9, 2021

By HANS DUVEFELT

Especially in these strange and uncertain times, many people feel uneasy. Some of them come to us with concerns over their state of mind.

In primary care, our job is in large part to perform triage. We strive to identify patients who need referral, medication or further evaluation. We also strive, or at last should strive, to reassure those patients whose reactions are normal, considering their circumstances.

A set of emotions we consider normal during the first weeks of the loss of a loved one may constitute pathology of protracted or if there is no apparent trigger.

But what is normal in today’s reality?

People today often have a low tolerance for deviations from the mean. They measure their heart rates, sleep times, steps taken, calories eaten and many other things on their smartphones. They compare their statistics to others’ or to their own from different circumstances.

Is it normal to sleep less when the last thing you do before bed is take in the latest disaster news? Is it normal to have a higher resting heart rate when you are threatened by eviction? Is it normal to feel sadness that life as we knew it doesn’t seem to be within our reach right now?

The worst thing we can do is tell people there is something wrong with them if we see them doing and hear them expressing what many other people also do.

It’s bad enough to feel bad, but even worse if you think your reaction is a sign of psychiatric illness or psychological or constitutional inferiority.

Selfish Much?

Sep 7, 2021

By KIM BELLARD

In a week where we’ve seen the bungled Afghan withdrawal, had Texas show us its contempt for all sorts of rights, watched wildfires ravage the west and Ida wreak havoc on a third of the country, and, of course, witnessed COVID-19 continue its resurgence, I managed to find an article that depressed me further. Thank you, Aaron Carroll.

Dr. Carroll – pediatrician, long-time contributor to The New York Times, and now Chief Health Officer of I.U. Health — wrote a startling piece in The Atlantic: We’ve Never Protected the Vulnerable. He looks at the resistance to public health measures like masking and wonders: why is anyone surprised?

Some of his pithier observations:

“Much of the public is refusing. That’s not new, though. In America, it’s always been like this.”
“COVID-19 has exposed these gaps in our public solidarity, not caused them.”
“America has never cared enough. People just didn’t notice before.”

Wow. What was that about Texas again?

Some of Dr. Carroll’s examples include our normally lackadaisical approach to influenza, our failure to recognize the dangers we often pose to immunocompromised people, our paltry family and sick leave policies, and our vast unpaid care economy. He could have just as well pointed to our (purposefully) broken unemployment system or the stubborn resistance to Medicaid expansion in 12 states (Texas again!), but you probably get the point.

Everyone likes to complain about our healthcare system – and with good reason – but it is not an abyss we somehow stumbled into. It’s a hole we’ve dug for ourselves, over time. We may not like our healthcare system but it is the system we’ve created, or, perhaps, allowed.

Health insurance was once largely community-rated, spreading the risk equally across everyone to protect the burden on the sickest, until some insurers (and some groups) figured out that premiums could be cheaper without it. Use of preexisting conditions and medical underwriting also served to protect the less vulnerable, until ACA outlawed those practices.